Provider Demographics
NPI:1083863609
Name:KILMER, MICHELE R (PNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:R
Last Name:KILMER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3794 ROCK SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8892
Mailing Address - Country:US
Mailing Address - Phone:479-756-0980
Mailing Address - Fax:479-756-0980
Practice Address - Street 1:5203 WILLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0876
Practice Address - Country:US
Practice Address - Phone:479-251-8000
Practice Address - Fax:479-444-6856
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX632703363LP0200X
ARA03324363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics